How Much Does Medicaid Pay For NEMT?
Medicaid’s non-emergency medical transportation (NEMT) benefit allows access to health care for low-income beneficiaries who may otherwise not have an affordable means of transport to health care appointments.
NEMT is also applicable to assist people with disabilities who need to attend doctor’s appointments frequently. The NEMT benefits are also provided to individuals with limited access to public transit options and have long commute times to doctor’s offices or hospitals, such as those living in rural areas.
NEMT benefits under Medicaid include a wide range of services, such as subways, public transit buses, and taxicabs, along with vans.
However, studies by the Transit Cooperative Research Program show that NEMT expenditures are around USD 3 billion every year, which is still less than 1% of the total annual Medicaid expenditure.
Medicaid Non-Emergency Medical Transport (NEMT) Benefits
Every state-sponsored Medicaid program includes facilities for providing essential transportation to beneficiaries to and from state-certified healthcare providers.
NEMT services do not feature in the statutory list of mandatory Medicaid benefits. However, these benefits are required by old federal regulations, which are based on the Department of Health and Human Services’ statutory authority and require state Medicaid plans to provide methods of administration that are necessary for their efficient and proper operation.
In addition, the state is also required to offer children from birth to 21 years of age and their families “necessary assistance with transportation” to and from healthcare service providers. This is dictated in the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.
Medicaid Non-Emergency Medical Transport (NEMT) Benefits Distribution
Every state Medicaid agency has considerable leeway in providing NEMT benefits to beneficiaries.
The federal law has broad guidelines that state Medicaid plans need to specify methods of providing NEMT. Most states use third-party brokerage agencies to coordinate transporting beneficiaries in exchange for monetary payments.
On the other hand, some states offer NEMT directly through free-for-service reimbursement plans. Still, some states even rely on a mix of brokerage, direct delivery, and public transit voucher programs. These are usually determined according to geographic and beneficial requirements.
You can seek reimbursement for NEMT services as an administrative expense or a medical service expense. For reimbursements, you should expect a limit of 50% of federal matching funds, like any other administrative expense.
Claims for reimbursement of transportation and administrative expenses give states greater flexibility and efficiency in delivering services. It also eliminates the free choice of provider requirement, thus allowing contracts with a single provider and alternative payment models, such as vouchers.
Claiming NEMT as a medical service expense allows the state to reimburse the expense under their regular Federal Medical Assistance Percentage (FMAP), which ranges from around 50% to 74.63%. This percentage depends on several factors, such as per capita income.
In addition, when you claim NEMT expense as medical expense, then it is subject to extra guidelines, which include offering the beneficiary a free choice of service providers and covering the expense of travel for attendant caregivers.
NEMT Benefits for Medicaid Beneficiaries
NEMT is an efficient and affordable means of traveling to and from healthcare providers for Medicaid beneficiaries.
A study shows that around 3.6 million Americans miss or delay medical care yearly due to a lack of available or affordable transport options. The study also showed that better access to NEMT is an efficient and cost-effective option for individuals suffering from several medical conditions.
In addition, the NEMT feature is incredibly useful for people who need preventive services, such as prenatal care or are suffering from chronic medical conditions, such as diabetes, asthma, or heart conditions.
Other studies have shown that patients who lack reliable medical transportation to medical care are more prone to develop chronic conditions that can escalate to a need for emergency care if not treated properly.
These researches have also proved that patients who lack adequate transport options to proper medical care are disproportionately elderly, disabled, and poor, who are more likely to have multiple health problems.
Today, most Medicaid beneficiaries use NEMT services to quickly access health care services, preventive care services, and also for chronic health conditions. A company that provides NEMT in 32 states stated that the most common reason for using NEMT is to access behavioral healthcare services, such as for mental health problems and substance abuse treatment, along with preventive care, such as doctor’s visits, specialist visits, physiotherapy/rehabilitation, and adult day healthcare services.
Tens of thousands of Medicaid beneficiaries rely on NEMT when there is a lack of affordable transport options. Studies have proven that NEMT is an efficient and cost-effective option for low-income, elderly and disabled Medicaid beneficiaries to get quick access to a plethora of necessary healthcare services.